Crohn's Disease: The Complete Guide to Medical Management

Gary R. Lichtenstein, MD, FACP, FACG, AGAF

Chapter 13: Oral Budesonide for Inflammatory Bowel Disease (continued)

Gordon R. Greenberg, MD, FRCP(C)

Budesonide is a nonhalogenated glucocorticosteroid that provides a different structure-activity profile when compared to prednisone, primarily via alterations of the D-ring of the basic hydrocortisone molecule (Figure 13-1). Substitution of a lipophilic acetyl group at the 16α and 17α positions of budesonide facilitates higher affinity for the glucocorticoid receptor that is 195-fold greater than hydro-cortisone and 15-fold greater than prednisolone (Table 13-1). Therefore, budesonide has a substantially enhanced topical antiinflammatory activity, which is about 1000-fold higher…